Sleep when your baby is sick: keeping nights safe and calm

When your baby is sick, nights get harder for everyone. A blocked nose, a cough or a temperature can mean more waking, shorter sleeps and a baby who only wants to be held. The safe-sleep rules don't change: your baby still sleeps on their back, on a firm, flat mattress, in their own cot. What changes is how much you feed, how often you check, and how closely you watch for signs that need help.

This guide covers keeping sleep safe while your baby is unwell, feeding, night checks, fever and medicine at night, getting the routine back afterwards, and when to get help. For specific illnesses, see baby coughing at night, stuffy nose and sleep and fever in babies.

Can I raise the cot or prop my baby up when they're sick?

No. It's one of the most common things parents want to do for a snuffly or coughing baby, and it isn't safe.

• The AAP's advice on sleep with a stuffy nose says propping your baby up on towels or pillows or inclining their mattress is not safe. A baby breathes most easily when their airway is straight, and on an incline their neck can bend forward or fall to the side.
• The Lullaby Trust says not to incline, tilt or prop the mattress, cot or baby, and that doing so doesn't help reflux and is unlikely to improve cold symptoms.
• Red Nose in Australia says an inclined surface encourages a baby's head to fall forward, which can block their airway.
• NICHD Safe to Sleep says inclined or tilted sleep surfaces aren't safe, and that many wedges and positioners don't meet safety guidelines.

The same goes for letting a congested baby sleep in a car seat, swing or bouncer. The AAP says babies in swings, rockers and bouncy chairs can't keep their head upright and airway straight, and that car seats and carriers don't provide enough support for safe sleep, so move your baby to their cot as soon as you can.

The rules that stay the same

Red Nose in Australia recommends always placing your baby on their back to sleep, keeping their head and face uncovered, keeping them smoke-free, and using a safe cot with a firm, flat mattress and no soft items. Rolled towels, extra pillows and soft toys added "for comfort" all count as soft items. See safe sleep for the full checklist.

Vomiting doesn't change this. Parents often worry that a baby on their back might choke if they're sick. The Lullaby Trust says no research has found this to be the case, and that babies are far safer sleeping on their backs.

How do I feed a sick baby through the night?

Feeds matter more than sleep when your baby is ill. Expect more night feeds for a while, and offer them.

The RCH fever fact sheet suggests extra breastfeeds or more frequent bottle feeds for a baby under 6 months with a fever, and small amounts to drink regularly for older children. The NHS fever page says to give plenty of fluids and, if your baby is breastfed, to keep breastfeeding as normal.

For bronchiolitis, the NHS bronchiolitis page suggests smaller feeds more often, and the RCH bronchiolitis fact sheet says feeding small amounts more often helps stop babies getting dehydrated. For tummy bugs, the NHS diarrhoea and vomiting page says to carry on breast or bottle feeding, try small feeds more often if your baby is being sick, and never make formula weaker than usual.

Clearing a blocked nose with saline drops before a feed can help; stuffy nose and sleep has the steps. Keep an eye on wet nappies, because fewer than usual is an early sign of dehydration. See dehydration signs.

How often should I check on my sick baby at night?

More often than usual. The NHS fever and bronchiolitis pages both say to check on your child regularly, including during the night, and the NHS urgent-help guide says to keep checking for new or changing symptoms when they're unwell, even during the night. There's no set timetable; how often depends on how unwell your baby is and what your doctor has advised.

When you check, look at:

1. Breathing. Is it comfortable, or fast, noisy or effortful? Any sucking in at the ribs or tummy, grunting or pauses?
2. Colour. Pink as usual, or pale, blue, grey or blotchy? On brown or black skin, check the lips, tongue, inside the cheeks, palms and soles.
3. Temperature. Feel the chest or the back of the neck, as the NHS SIDS guidance suggests. Hands and feet often feel cool, and that's normal.
4. Waking. Do they stir and settle as usual when you touch them, and wake for feeds?
5. Nappies. Are they wet as often as usual?

Why room-sharing helps when your baby is unwell

The Lullaby Trust's room-sharing advice says having your baby sleep in the same room as you lowers the risk of SIDS and means you can keep an eye on them and attend to them if they need anything. It, Red Nose in Australia and the NHS all say your baby should sleep in their own cot or bassinet in your room for at least the first 6 months, day and night. The Lullaby Trust's advice on caring for a baby during illness also says an unwell baby should sleep in their own separate space, such as a cot or Moses basket, in the same room as you.

If your older baby or toddler already sleeps in their own room, the sources don't say you must move them back. Many families bring the cot into their room for a few nights, or sleep close enough to hear, while their child is unwell. Keep the cot set up exactly as usual. The Lullaby Trust says no device can replace a parent or carer being in the same room.

Bed-sharing and the sofa

It's tempting to bring a sick baby into your bed so you can keep watch. The Lullaby Trust's co-sleeping advice says that if you are unwell, your baby will be safest in a separate sleep space, and its illness advice explains that when your body is fighting an infection you may sleep more deeply and be less responsive, and medicines may make you drowsy. The Lullaby Trust also says never to fall asleep on a sofa or armchair with your baby. If you're exhausted, put your baby in their cot, or hand them to another adult who is awake. See bed-sharing.

Slings and contact naps

Holding a sick baby while you're awake is lovely comfort. Take extra care in a sling: the US Consumer Product Safety Commission says many babies who died in slings had breathing problems such as a cold, were premature or were a low birth weight twin. Keep their face in view and their chin off their chest. See contact napping.

How should I handle fever and medicine at night?

Dress them as usual. The Lullaby Trust says not to wrap a baby with a cold or fever up more than usual, and to dress them for the room. The NHS says not to cover a child with a fever in too many clothes or bedclothes, and not to undress or sponge them to cool them. The NHS suggests a room of about 16 to 20°C for sleep.

You don't need to wake them for fever medicine. Seattle Children's Hospital says not to wake your child to give fever medicine, and to make sure they get enough rest. The RCH says there's no need to treat a fever if your child seems comfortable and is drinking, and the NHS says to give paracetamol or ibuprofen if your child is distressed or uncomfortable. If a doctor has prescribed a medicine at set times, such as an antibiotic, follow their instructions or ask the pharmacist how to fit doses around sleep.

Follow the label, not a guess. The NHS fever page says:

• don't give paracetamol to a baby under 2 months
• don't give ibuprofen to a baby under 3 months, under 5 kg, with chickenpox or who is dehydrated
• don't alternate paracetamol and ibuprofen unless a doctor or nurse tells you to
• check the packaging or leaflet to make sure the medicine suits your child

Ask a pharmacist about the right product and dose for your baby's age and weight, and write down each dose and time so night-time doses aren't doubled. The AAP's fever guide says a baby under 12 weeks with a fever needs to be seen, and not to give fever medicine before then. The NHS urgent-help guide goes further: for a baby under 3 months with a temperature of 38°C (100.4°F) or higher, call 999 or go straight to A&E.

Sleep is good, but too sleepy isn't. Rest helps, but a baby who is much sleepier than usual, too sleepy to feed, or hard to wake needs 999.

How do I get my baby's sleep back on track after being sick?

Illness often leaves a trail: extra night feeds, being held to sleep, an earlier or later bedtime. That's fine while your baby is unwell. The RCH night waking fact sheet says setbacks can happen with illness, that it's okay to pause your child's sleep routine while they're sick and return to it later, and that going back to it can feel harder at first but is likely to get better with time.

1. Wait until they're properly well. Eating, drinking and playing normally is a good sign. A lingering cough can disturb sleep for a while; the NHS says a bronchiolitis cough usually gets better in 3 weeks.
2. Start with the bedtime routine. The NHS guide to helping your baby sleep says a simple, soothing bedtime routine may help babies settle. Bring back your usual order first.
3. Ease off extra help gradually. If you've been feeding or rocking to sleep more, step back a little at a time. See responsive settling.
4. Review extra night feeds. Once your baby is feeding well by day again, extra night feeds may drop away on their own. See dropping night feeds if they don't.
5. Give it time. Keep your approach steady; one rough night doesn't mean it isn't working.

When to get help

These tiers follow the NHS urgent-help guide and the sources below. If you're unsure which applies, call NHS 111.

Call 999 now if your baby:

• is struggling to breathe, breathing very fast, grunting, or sucking in at the tummy, ribs or neck
• pauses in their breathing or breathes irregularly
• has blue, grey, very pale or blotchy skin, lips or tongue
• is floppy, much sleepier than usual, hard to wake or can't be woken
• is much sleepier than usual and not feeding, or is too sleepy to feed
• has a weak, high-pitched or continuous cry, or a cry that doesn't sound like their normal cry
• has a rash that doesn't fade when you press a glass on it, or a bulging soft spot
• has a seizure
• has green or yellow vomit, vomits blood, or has vomit that looks like coffee grounds
• has had no wet nappy or wee for 12 hours, or has a sunken soft spot, sunken eyes, or cold, mottled hands and feet
• is under 3 months and has a temperature of 38°C (100.4°F) or higher
• is 3 to 6 months old and has a temperature of 39°C (102.2°F) or higher
• has a temperature below 36°C (96.8°F) when rechecked

These come from the NHS urgent-help guide, the NHS fever, bronchiolitis and diarrhoea and vomiting pages, the RCH dehydration fact sheet and the Sydney Children's Hospitals Network in Australia, which says green or yellow vomit needs an ambulance or A&E. Where sources give different tiers, we use the stricter one. The RCH bronchiolitis sheet also says to call an ambulance for breathing that isn't regular or pauses.

Get medical help today (same-day GP, after-hours doctor or NHS 111) if your baby:

• is refusing feeds or feeding much less than usual; the RCH bronchiolitis sheet says to see a doctor if your baby is feeding less than half their normal amount
• has fewer wet nappies than usual; the RCH says a baby under 6 months with any sign of dehydration needs a doctor
• is under 12 months and you're worried, or has stopped breast or bottle feeding while ill, as the NHS diarrhoea and vomiting page advises
• has a temperature that has lasted 5 days or more
• is very tired, irritable or not their usual self
• is under 6 months and has a cough (see baby coughing at night)
• has bronchiolitis and is still sick after 7 days, as the RCH advises

Talk to your GP or health visitor if a cough lasts more than 4 weeks or keeps disturbing sleep, which the RCH cough fact sheet says should be checked, your baby keeps catching one illness after another and sleep never settles, sleep hasn't recovered a few weeks after your baby is well, or you're finding broken nights hard to cope with. You can also call your health visitor, or NHS 111.

If you have thoughts of harming yourself or your baby, put your baby safely in their cot. Then call Samaritans on 116 123 or 999 now.

What's worth noting while your baby is sick?

Keep a simple log: temperatures with times, medicines with doses and times, feeds and wet nappies, and how your baby seemed at each night check. It helps you avoid doubling doses at 3 am, spot whether feeds are dropping, and give a doctor a clear picture. A short video of your baby's breathing can help too, but never delay getting help to make one.